Use of Single-Dose and Multiple-Dose Vials and Solution Containers

ASGE Policy Statement on the Use of Single-Dose and Multiple-Dose Vials and Solution Containers

The American Society for Gastrointestinal Endoscopy (ASGE) promotes the highest standards for endoscopic practice, including the safe use of sterile parenteral medications during endoscopic procedures. ASGE bases its policy for the use of single-dose and multiple-dose vials and solution containers on the Centers for Disease Control and Prevention’s (CDC’s) 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

Practitioners must adhere to basic principles of aseptic technique when administering parenteral medications. Whenever possible, use of single-dose vials is preferred over multiple-dose vials, particularly when medications will be administered to multiple patients. ASGE does not support the administration of medications from single-dose vials or ampules to multiple patients or the practice of combining residual contents for subsequent use. Bags or bottles of intravenous solution should not be used as a common source of supply for multiple patients.

ASGE recognizes that shortages of sterile parenteral medications have occurred and have impacted the delivery of care. However, ASGE’s overarching priority is the protection of patients from harm, and ASGE does not support any practice that could lead to increased risk of transmissible disease. ASGE accepts the CDC’s conclusion that “shortages of some essential medications may warrant implementation of meticulously applied practice and quality standards to subdivide contents of single-dose/single-use vials, as stated in the United States Pharmacopeia (USP) General Chapter 797 Pharmaceutical Compounding-Sterile Preparations,” a practice that would be feasible only in a strictly controlled setting with individuals fully knowledgeable about, and compliant with, all USP requirements.